MASTECTOMY

From Big Medical Encyclopedia

MASTECTOMY (Greek mastos a breast + ektome excision, removal) — operation of removal of a mammary gland. The hl is applied. obr. as method of operational treatment of malignant tumors of a mammary gland. The purpose of operation — removal of body together with regional cellulose and limf, the nodes which are a zone of lymphogenous innidiation. The existing options M. differ from each other on the volume of an operative measure: simple M. consists in amputation of a mammary gland together with a fascia of a big pectoral muscle and cellulose of axillary area (if in it nodes are defined increased limf); radical M. consists a mammary gland the uniform block together with hypodermic cellulose, big and small pectoral muscles and cellulose of subclavial, axillary and infrascapular areas at a distance; expanded radical M. includes also single-step removal okologrudinny limf, nodes. In 1948 Mr. Peyti and Dayson (D. H. Patey, W. H. Dyson) offered conservative option of radical M., at Krom the big pectoral muscle remains that, according to authors, reduces duration of operation, reduces blood losses) and creates more favorable conditions for function of an upper extremity.

Radical M. is developed by Holsted and Maier (W. S. Halsted, Mayer) and is the leading method of operational cancer therapy of a mammary gland. Suggested to expand borders of an operative measure at a breast cancer in 1948 Mr. of Margottini and in 1951 Mr. J. A. Urban, having developed expanded radical M. V equipment of the USSR expanded radical M. in 1955 S. A. Holdin for the first time applied.

Indications

Simple M. is applied as palliative intervention concerning initially inoperable breast cancer with the big, breaking-up, menacing with bleeding tumoral nodes; at tumors, small by the sizes, with existence of the remote metastasises; at contraindications to radical M.

Radikalnaya M. it is shown at all stages of a resectable breast cancer: at patients with I and IIA stages as an independent method of treatment; II6, IIIA and IIIB stages in a complex with beam and chemotherapy (see. Mammary gland, tumors ). The conservative option of radical M. is shown at limited local process, in cases of bilateral damage of mammary glands and at patients of old age, the Crimea radical M. Rasshirennaya is contraindicated radical M. is shown in I and II stages of a disease at localization of a tumor in internal and central departments of a mammary gland when okologrudinny limf, nodes can be the first stage of innidiation.

Contraindications. Main of them — generalization of a tumor and existence of serious associated diseases.

Technique

Fig. 1. The diagrammatic representation of options of skin cuts (are designated by a solid line) at a mastectomy depending on localization of a tumor (the dotted line designated borders of excision of cellulose; at the left below at each drawing — a configuration of a skin seam).
Fig. 2. Diagrammatic representation of stages of a radical mastectomy: and — mobilization of a small pectoral muscle (the dotted line planned border of crossing) — pectoral muscles are crossed, in — cellulose around a vascular bundle — a surgery field after removal of a mammary gland is removed; 1 — a big pectoral muscle, 2 — a small pectoral muscle, 3 — a clavicular part of a big pectoral muscle, 4 — a vascular bundle.

Special preparation before operation M. usually is not required. It is applied inhalation anesthesia (see), local anesthesia can be in rare instances used.

The skin section is made, otstupya not less than on 5 cm from the palpated edges of a tumor; the configuration of a section depends on localization of a tumor (fig. 1). Skin rags otseparovyvat medially to the middle of a breast, lateralno to the back axillary line, up to a clavicle, down to the middle of epigastriß area. Big and small pectoral muscles are crossed at the place of an attachment to a humeral bone, keeping a clavicular part of a big pectoral muscle for cover of a neurovascular bunch (fig. 2, and, b). Release of cellulose is begun from the sternal end of a clavicle, in the stupid way shifting it from a front and zadnenizhny surface of subclavial and axillary veins (fig. 2, c), from space between lateral edge of a shovel and a chest wall, from axillary area down the direction to a mammary gland. The mammary gland is delayed to a breast, shortly cross fibers of big and small pectoral muscles from a chest wall and deleted with the uniform block with pectoral muscles and the emitted cellulose (fig. 2, d). After a careful hemostasis with the help diathermocoagulations (see) and catgut ligatures to the axillary area through counteropening (see) enter a rubber drainage which is connected to a constant suction for 3 — 5 days (see. Aspiration drainage ). At some locally common forms of cancer with a considerable tension of edges of a wound and danger of a necrosis of skin one of options is applied skin plastics (see), is more often by local movement of skin rags.

At conservative option of radical M. after separating of skin rags cut a superficial fascia along edge of a breast and together with a mammary gland separate from a big pectoral muscle to its lateral edge. The edge of a big pectoral muscle is lifted up, the small pectoral muscle is cut from a coracoid of a clavicle and a chest wall, reduced to a mammary gland. Regional cellulose is emitted the same as at radical M., and deleted with the uniform block with a mammary gland and a small pectoral muscle.

At expanded radical M., having separated a mammary gland with pectoral muscles from a chest wall as at radical M., resect cartilages of the II—V edges and delete okologrudinny cellulose with limf, nodes in the uniform block with a mammary gland, muscles, axillary and subclavial and infrascapular cellulose. The formed defect of a chest wall is covered with a clavicular part of a big pectoral muscle, freely replaced piece of a wide fascia of a hip or explant.

At M. it is necessary to observe the principles of an ablastika (see. Tumours, surgical treatment ). During M. there can be wounds of a subclavial vein demanding in certain cases imposing vascular seam (see); at expanded radical M. can arise pheumothorax (see).

Postoperative current and outcomes

Postoperative current and outcomes depend on option M. In the first 3 — 5 days after operation the bed rest is recommended. In order to avoid an otvisaniye of a hand and lag of skin rags from a chest wall under a hand enclose a pillow, at several o'clock after operation stack a load on subclavial area. The unlimited movements in joints of a brush, an elbow joint and the careful, unsharp movements in a shoulder joint are recommended. The first bandaging is made on 3 — the 5th day after M.: take drainages, apply a dry aseptic bandage. The subsequent bandagings make according to indications (blotting of a bandage, pain in a wound, high temperature). In the absence of a tension of skin rags and a normal wound repair seams begin to remove with 10 — the 14th day.

The most frequent next complications after M. are: accumulation in a wound of serous and bloody liquid owing to an insufficient prileganiye of skin rags to a wall of a chest cavity and a regional necrosis of skin rags at their strong tension at the time of imposing of skin seams (in places of the greatest tension make notches for prevention of a necrosis of skin). In the remote terms, sometimes in several years after M., can arise lymphostasis (see) also swelled.

The lethality after M., according to various authors, makes from 0,3 to 1,4%; the long-term results depend from a wedge, stages of a disease and the nature of the carried-out treatment.


Bibliography: Clinical oncology, under the editorship of H. N. Blochina and B. E. Peterson, t. 1, page 655, M., 1979, bibliogr.; Peterson B. E. Surgical treatment of malignant tumors, page 179, M., 1976; Holdin S.A. and D y m and r-with to and y L. Yu. Expanded radical breast cancer operations, L., 1975, bibliogr.; McWhirter R. Simple mastectomy and radiotherapy in thetreatment, of breast cancer, Brit. J. Radiol., v. 28, p. 128, 1955; P a t e y D. H. a. D y s o n W. H. Prognosis of carcinoma of breast in relation to the type of operation performed, Brit. J. Cancer, v. 2, p. 7, 1948; Urban J. A. Radical mastectomy in continuity with en bloc resection of internal mammary lymph-node chain, Cancer, y. 5, p. 992, 1952.


E. G. Vishnyakova.

Яндекс.Метрика